Richfield City Building Department PERMIT#
BUILDING PERMIT
(This application becomes a permit upon receipt of require approvals and acceptance of required fees) PARCEL#
DESCRIPTON OF WORK:
INSPECTIONS:
435-896-8639
Please Call 24 hours prior to
inspection.
Date: ________________
Zone: ________________
Project Valuation (REQUIRED):
☐
Residential
☐ Commercial (Name of Business to Occupy space _________________________________)
☐ New ☐ Addition ☐ Remodel ☐ Tenant Finish ☐ Sign
☐ Demolitions ☐ Other ________________________________________________
Job Address:
(OFFICE USE ONLY)
Owner: Phone #:
PERMIT TYPE FEES
Owner Address: City/St.: Zip:
Building Subtotal
Applicant: Phone#:
Plan Check
Applicant Address: City/St.: Zip:
State Surcharge
CONTRACTOR
Zoning Review
Name: State License# Phone#
Water Impact Fee
General:
Sewer Impact
Fee
Email Address:
Landfill Fee
Electrical:
Traffic Area Impact
Payback Agreement
Mechanical:
Other
Plumbing:
TOTAL: $
Architect/Engineer:
Prepaid Plan Ck. ( )
Other:
Receipt #
CHECK ONE
Rec’d By: Date
☐
LICENSED CONTRACTOR DECLARATION
I hereby affirm that all work will be performed by
contractors licensed under the Construction Trades
Licensing Act (58-55,UCA) whose licenses are in full
force and effect.
If contractors have not been selected at the time of
the application for this permit, the permit is issued only on
the condition that currently licensed contractors shall be
selected by the application, that the applicant shall
provide the names and license numbers of the
contractors to the municipality and shall enter the same
names and numbers on the permit before they begin their
work.
☐ OWNER-BUILD DECLARATION
I hereby claim exemption from the requirement for
licensing under the Construction Trades Licensing Act
(58-55, UCA) because work will be performed by the
owner of the property for his/her private, noncommercial,
non-public use. Any work not performed by the owner will
be performed by a contractor licensed under the
Construction Trades Licensing Act, and the names and
license numbers of the contractors shall be provided to
the municipality and shall be entered on the permit before
their work is begun.
Check #
BALANCE DUE: $
Receipt #
Rec’d By: Date
Check #
This permit shall become null and void if work is not commenced with 180 days, or if work is suspended or
abandoned for a period of 180 days or more at any time after the work has commenced. Commencement or
continuation of work shall be verified only by inspection report from and inspector for the municipality. All required
inspections shall be requested at least one working day before they are to be made, inspection are required before
any work is covered. Please call if you need further information about when an inspection is required.
I hereby certify that I have read and examined this permit and that the information provided by me is true and
correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified
herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any
other state or local law regulating construction or the performance of construction.
________________________________________ ________________________ __________________________________
Signature of Applicant Date Printed Name
(OFFICE USE ONLY)
Type of Const.
Occupant Load
Group / Division
Square feet
Fire Sprinklers ☐ Yes ☐ No